Fillable Form Aa-33a - Administrative Appeal Form (Page 2 of 2) in pdf

Form Aa-33a - Administrative Appeal Form Page 2

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New York State Department of Motor Vehicles

DMV USE ONLY

ADMINISTRATIVE APPEAL FORM (AA-33A)

VEHICLE AND TRAFFIC LAW ARTICLES 3-A and 12-A

(THIS FORM IS NOT TO BE USED TO APPEAL TRAFFIC VIOLATION BUREAU TICKETS)

WHAT RECORDS ARE REVIEWED

Any exhibits submitted at the hearing will become part of the appeal record. The Appeals Board reviews the entire record created at the hearing. The Board

will review a transcript of the hearing only if you order it and pay for it in a timely manner.

To receive copies of hearing exhibits for personal use, submit a

to: DMV FOIL OFFICE,

FREEDOM OF INFORMATION LAW (FOIL) request

6 Empire State Plaza, Albany, NY 12228. Information for obtaining DMV records and FOIL forms is available online at:

APPEAL ARGUMENTS

IN THE SPACE BELOW YOU MUST STATE IN DETAIL THE REASON(S) FOR THIS APPEAL and for needing a stay (if requested). PLEASE TYPE OR

PRINT CLEARLY.

Attach additional pages, if necessary, and write your name on every page.

Personal appearances and oral agruments are not permitted

If a transcript is ordered, you will have 30 days to submit additional arguments from the date of the transcript invoice. After the 30-day period,

on appeal.

your appeal will be reviewed and decided. You will receive written notification of the outcome of the appeal.

SIGN AND DATE YOUR APPEAL

I affirm under penalty of perjury that all of the information on this form and all supporting documents submitted with this appeal are true, and that no prior

appeal has been filed in this matter.

Sign Here

Date

BE SURE THAT YOU:

Pay the non-refundable appeal fee of $10

appealed. Enclose a check or money order payable to “Commissioner of Motor Vehicles”.

for EACH case

Submit your appeal form and appeal fee(s) to the Appeals Board

within 60 days of the date of your order or notice

Provide

on page two. If requesting a stay, provide

on page two.